Improving Influenza Vaccination Rates Among Elderly Patients in a Singapore Polyclinic: An Audit Project
Sang-Wook SONG, Su-Young JUNG, Tae Mi YOON, Tae Yeol KIM and Ha-Na KIM
Influenza infection is associated with considerable morbidity and mortality among individuals aged 65 and above. Influenza vaccination has been shown to significantly reduce complications in this vulnerable group, leading to annual vaccination recommendations from various authorities, including the Centers for Disease Control and Prevention.In alignment with the World Health Organization’s target of a 75% influenza vaccination coverage rate, this audit project aims to enhance influenza vaccination uptake among a cohort of elderly patients managed under the “Teamlet Care Model” in a Singapore polyclinic.A root-cause analysis was conducted to identify key factors contributing to the low vaccination rate. A multi-voting was carried out to identify top causes, which include limited emphasis on influenza vaccination among doctors and nurses, high cognitive load on healthcare staff during consultations, and limited patient awareness of vaccination benefits.Targeted interventions were implemented, using the Plan-Do-Study-Act (PDSA) cycle as a model for improvement. Initial intervention include a continuing medical education (CME) session on vaccination importance, messaging prompts via Microsoft Teams, and visual cues strategically placed in workspaces to serve as reminders. Staff feedback has indicated an increase in vaccination offers to the target population as a result of these interventions. The uptake of influenza vaccination increased from a baseline of 33.28% (median = 726) to 36.57% (median = 876) over a period of 6 months. The influenza vaccination rate continued to increase post-intervention to date (February 2025), to 36.94% (median = 886).The pre- and post-intervention analysis revealed that the intervention led to an increase of 117 vaccinated elderly patients. A local study that reported 36 million cost savings per 100,000 patients over a 10-year period. Estimated annual cost savings projected would be SGD 4,212 for the current project.To maximize impact, interventions can be expanded clinic-wide to benefit a larger patient population. Regular talks can be carried out to reinforce the importance of influenza vaccination among doctors. Pop-up reminders for target patients can be integrated to the electrical medical records system to further enhance recall. To further enhance sustainability, a quick-response code can replace brochures to reduce paper waste and minimize manpower for distribution.
